Lung cancer in young adults aged 35 years or younger: A full-scale analysis and review

Abstract

Objectives : Lung cancer in young adults is a distinct disease with particular socioeconomic implications. This study aimed to clarify the clinicopathological characteristics, best interventions, and outcomes of this distinctive entity. Methods : A retrospective review of patients with lung cancer was performed in our institute from January 2010 to June 2017. Young adults were defined as between 18 and 35 years old. Demographic, clinicopathological, therapeutic, and prognostic data were systematically analyzed. Results : From a total of 8734 patients, 120 (1.37%) were young adults, of which 82 with complete hospital records were included in this study. A high proportion had adenocarcinoma (45%) and late-stage disease (49.21% stage IV at diagnosis). Pleura (38.71%) were the most common metastatic site, followed by bone (35.48%) and lung (25.81%). The majority (68%) had single organ metastasis. Young patients had an increased frequency of gene mutations. Among the 18 patients for whom epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) status was determined, 10 had sensitive EGFR mutations while 5 had ALK rearrangement; only 3 patients were driver gene mutation-negative. The 1-year overall survival (OS) rate was 62.31% and the 3- and 5-year survival rates were both 53.31%; median OS was not achieved (range, 3-86 months). Male sex, negative or unknown gene mutation status, stage IV, and squamous or small cell lung cancer were associated with poor prognosis (OS) in early-onset lung cancer. Conclusions : Lung cancer in young adults is distinctive, with adenocarcinoma and stage IV at presentation being predominant characteristics. Gene mutation assessment should be mandatory in this subgroup due to the increased likelihood of positive driver gene alterations, as individualized targeted therapy may achieve superior outcomes.

Clinicopathological Profile of Lung Cancers at an Institute from South India—A Record Based Retrospective Cohort Study

“…Epidermal growth factor receptor (EGFR) and KRAS activating mutations are the most common genetic alterations in AC. Liu et al [19] in their study on young adults with lung cancer found that 45% of the 82 patients had AC and 49.21% had late-stage (Stage IV) disease at diagnosis. Among the 18 patients for whom EGFR and anaplastic lymphoma kinase (ALK) status was determined, 10 had sensitive EGFR mutations and 5 had ALK rearrangement.…”

“…Among the 18 patients for whom EGFR and anaplastic lymphoma kinase (ALK) status was determined, 10 had sensitive EGFR mutations and 5 had ALK rearrangement. It is speculated from studies [19] on NSCLC among those aged ≤40 years that frequent genomic alterations occur in this subset. We need to delineate genetic/molecular contributions as marker panels for risk and prognosis of lung cancer, which in-turn will address their application as screening tools in the clinical setting [20].…”

Non-Small Cell Lung Carcinoma Presenting With Severe Tracheal Deviation: A Case Report

“…Literature about the clinical characteristics, pathophysiology, and time trends of young patients with lung cancer is very limited, having only a 1.37% incidence rate in ages of 18 to 35 [ 2 ]. However, one study called the Surveillance, Epidemiology and End Results (SEER) database created in 2010 gives us some insight regarding the diagnosis of NSCLC in young adults.…”

An Uncommon Lung Neoplasm in a Young Patient: Diagnostic Challenges

“…The timely diagnosis of pulmonary neoplasms in young non-smoking women is notoriously challenging, and most cases are detected as stage IV metastatic disease [ 12 ]. Specifically, the rarity of ASC cases described within this epidemiological profile not only hinders the deployment of diagnostic procedures, but also complicates clinical management decisions and prognostic prediction [ 12 , 13 ]. Therefore, it is crucial to conduct more studies to better inform the clinical, pathologic, and radiographic aspects of lung ASC in these patients.…”